How effective is community mobilisation in HIV prevention among highly diverse sex workers in urban settings? The Aastha intervention experience in Mumbai and Thane districts, India

Abstract

Background This paper examines the association between degree of confidence in collective efficacy and self-efficacy for condom use and empowerment among heterogeneous female sex workers (FSWs) in two metropolitan Indian cities with high HIV prevalence. Methods The study utilises data from the Behavioural Tracking Survey, a cross-sectional behavioural study with 2106 FSWs recruited from 411 intervention sites in Mumbai and Thane. The key independent measures used determine the degree of confidence in collective efficacy (belief in the power to achieve goals and address problems together) and outcome measures included: self-efficacy for condom use with occasional clients and condom use with regular partners, self-confidence in handling a crisis situation and public speaking ability. Univariate and multivariate statistical methods were used to examine the study objectives.Results Of the analytical sample of 2106 FSWs, 532 (25.3%) reported high degree of collective efficacy for achieving certain goals and 1534 (72.8%) reported collective efficacy for addressing specific problems. FSWs reporting a higher collective efficacy as compared with those reporting lower collective efficacy were as follows: more likely to negotiate condom use with occasional clients (60.3% vs 19.7%; adjusted OR (AOR) ¼6.3, 95% CI 4.8 to 8.4) as well as regular partners (62.8% vs 20.2%; AOR ¼6.4, 95% CI 4.9 to 8.4); confident in facing troublesome stakeholders (73.5% vs 38.8%; AOR ¼4.3, 95% CI 3.3 to 5.6), confident in supporting fellow FSWs in a crisis (76.1% vs 49.6%; AOR ¼2.9, 95% CI 2.2 to 3.7), received help from other FSWs when a client or partner was violent (73.9% vs 46.3%; AOR ¼3.5, 95% CI 2.7 to 4.5) and had stood up to the police or madams/brokers to help fellow FSWs in the past 1 year (5.8% vs 3.3%; AOR ¼2.7, 95% CI 1.5 to 4.9). Conclusion The results suggest that the strategy of collectivisation in HIV prevention programme has much broader benefits than merely the promotion of safer sex practices. Future HIV prevention interventions in India and elsewhere may include collectivisation as the core strategy within HIV prevention programmes.

Investing in Communities: Evaluating the Added Value of Community Mobilization on HIV Prevention Outcomes Among FSWs in India

“…The importance of collectivization is consistent with other studies of Avahan that show collective identity, efficacy, and agency associated with consistent condom use [21, 23, 38]. …”

Association between Community Collectivization and Mental Depression among Men Who Have Sex with Men in Andhra Pradesh, India

“…It is also evident from the previous studies that structural approaches and community mobilization are an integral part of successful interventions in reducing the HIV risk vulnerability among key populations (e.g. female sex workers, men having sex with men and injecting drug users) [30,33,36,37,[50][51][52][53]. When mental health in the context of community collectivization approach among MSM is discussed, there is negligible evidence in this sphere of mental health.…”

Community mobilisation for HIV prevention in India: What difference does it make?

“…This is an important result, given that similar efforts in the past have floundered in the face of adversity 9. A number of measurable changes were noted including increased confidence in the sex workers' ability to negotiate condom use, in speaking up for their rights and in handling crises 10 11. There are encouraging indications that sex workers who were associated with the community mobilisation activities were more likely to use services such as clinical services for care of sexually transmitted infections 11.…”